病态窦房结综合征患者非典型性胸痛的临床意义

目的探讨病态窦房结综合征患者非典型性胸痛的病因及临床意义。方法 对34例临床诊断为病态窦房结综合征且需安装心脏永久起搏器、同时伴有非典型性胸痛的患者,在行心脏永久起搏器植入术的同时或术前和术后行冠状动脉造影术,分析冠状动脉病变及左心室功能,其中21例在冠状动脉造影时行乙酰胆碱试验。结果31例患者冠状动脉均正常或狭窄程度<50％,3例患者冠状动脉狡窄程度>75％,但在心动过缓患者可见冠状动脉血流速度明显缓慢。部分患者左心室明显扩大、左心室射血分数足室壁运动降低,9例乙酰胆碱试验阳性。无严重冠状动脉病变者多在起搏器植入术后或合并钙拮抗剂治疗后胸痛消失。结论 病态窦房结综合征患者的非典型性胸痛多数不具有严重冠状动脉病变基础,可能与心动过缓所导致的冠状动脉血流缓慢或冠状动脉痉挛有关,在安装起搏器和服用钙拮抗剂后胸痛多缓解。

吸烟和高脂血症是冠状动脉痉挛的重要危险因子

目的 探讨临床上具有心绞痛样胸痛发作但无显著冠状动脉狭窄患者胸痛的病因 ,并甄别与冠状动脉痉挛相关的临床危险因子。方法 对 2 75例临床上具有心绞痛发作但冠状动脉造影无显著冠状动脉狭窄患者进行乙酰胆碱试验 ,以冠状动脉狭窄程度达到 90 %以上伴胸痛发作和 /或心电图缺血性改变为冠状动脉痉挛的诊断标准。Logistic回归强迫引入法分析冠状动脉痉挛与性别、年龄、高血压、糖尿病、吸烟、血脂代谢紊乱和心电图活动平板试验结果的关系 ,并根据乙酰胆碱试验结果分组比较左室射血分数和舒张末期压力。结果 2 71例资料完整的患者中乙酰胆碱试验的阳性率为 38% ,Logistic回归分析表明 ,吸烟和高脂血症分别使冠状动脉痉挛的优势比 (OR)值增加 4 2倍和 2 3倍 ,糖尿病与冠状动脉痉挛呈显著负相关 ,冠状动脉痉挛对左室功能无明显影响。结论 冠状动脉痉挛是冠状动脉造影正常的心绞痛患者的重要病因之一 ,吸烟和高脂血症是冠状动脉痉挛的重要危险因子。

Smoking and hyperlipidemia are important risk factors for coronary artery spasm

To investigate the role of coronary artery spasm in the etiology of chest pain lacking significant coronary stenosis and to identify the clinical risk factors related to coronary artery spasm Methods Two hundred and seventy five patients with chest pain, but without significant coronary artery stenosis underwent the intracoronary acetylcholine test Coronary artery spasm was diagnosed while coronary artery stenosis increased to 90% and was accompanied by the usual chest pain with or without ischemic changes on electrocardiogram Logistic regression was employed to investigate the relationships between coronary artery spasm and sex, age, hypertension, diabetes mellitus, smoking, hyperlipidemia and results of electrocardiographic treadmill stress te st Left ventricular ejection fraction and end diastolic pressure were compared between spasm group and non-spasm group Results Coronary artery spasm was detected in 103 out of 271 patients, a rate of 38% Logistic regression analysis showed that smoking and hyperlipidemia increased the relative risk of coronary artery spasm 4 2 times and 2 3 times, respectively There was a significantly negative relationship between diabetes mellitus and coronary artery spasm Furthermore, there was no coronary artery spasm detected in left ventricular ejection fraction and end diastolic pressure Conclusions Coronary artery spasm was one of the important etiological factors for patients with chest pain but no coronary artery stenosis Smoking and hyperlipidemia were the main clinical risk factors for coronary artery spasm